New in the Literature: Physical Therapy for Acute Whiplash (Lancet. 2013;381(9866):546-556.)

Wednesday, March 13, 2013

New in the Literature: Physical Therapy for Acute Whiplash (Lancet. 2013;381(9866):546-556.)

In
a 2-step trial conducted in the United Kingdom, providing active management
consultation for patients with acute whiplash injury in emergency departments
(ED) did not show additional benefit compared with usual care consultations,
say authors of an article published in
February in The Lancet. Physical
therapy resulted in a modest acceleration to early recovery of persisting
symptoms but was not cost effective from the National Health Service's (NHS)
perspective. Usual consultations in EDs and a single physical therapy advice
session for persistent symptoms are recommended, the authors add.

Step
1 was a pragmatic, cluster randomized trial of 12 NHS Trust hospitals including
15 EDs that treated patients with acute whiplash associated disorder of grades
I-III. The hospitals were randomized by clusters to either active management or
usual care consultations. In step 2, the researchers used a nested individually
randomized trial. Patients were randomly assigned to receive either a package
of up to 6 physical therapy sessions or a single physical therapy advice
session. Randomization in Step 2 was stratified by the center. Investigator-masked
outcomes were obtained at 4, 8, and 12 months. The primary outcome was the Neck
Disability Index (NDI). Analysis was intention to treat, and included an
economic evaluation.